Key Points
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Recent study has highlighted the problem of diversion of drugs of addition from hospitals.
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There are higher rates of suicide (by 62%) by self-poisoning among doctors than by people in other occupations.
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Multiple stressors increases the risk of anxiety and depression in health care professionals.
A recent coroner’s inquest into the death of a RANZCOG trainee from an accidental overdose of intravenous drugs, including propofol, midazolam, and fentanyl, has highlighted the problem of diversion of drugs of addiction from hospitals. The inquest also highlighted a number of other issues which are of relevance to hospitals and doctors.
A trainee had become distressed and depressed following a number of unsuccessful attempts to pass the College exams. The Coroner found that the trainee’s partner, an anaesthetic registrar, had obtained the drugs that she self-administered, had written prescriptions for her and had assisted with “home hospitalisation” in the weeks prior to her death. Criticism of this lapse in professional judgment was made, noting that doctors are actively discouraged from prescribing to family members or close friends.
Other issues explored during the inquest were the storage of drugs of addiction within hospitals, the RANZCOG training program and the Deceased’s deteriorating mental state in the months prior to her death.
The anaesthetic expert for the Coroner noted that propofol has increasingly become the agent of choice for abuse among doctors. Most cases of propofol abuse involve its use for recreational purposes, stress relief and to alleviate insomnia. The narrow margin for safety makes propofol a lethal drug, with studies suggesting propofol abuse has the highest mortality rate. Anaesthetists have a higher rate of propofol abuse than other doctors because the drug is widely used in their clinical practice.
Interestingly, a recent study published in November 2016 in the medical journal, Addiction, which examined 404 drug-caused deaths in Australian healthcare professionals revealed that in 18% of cases, the drugs had been obtained through the workplace. Anaesthetic drugs were detected in 11% of cases. A mental health diagnosis and/or previous self-harm was reported in almost half of the 404 healthcare professionals who had died.
Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression. Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians. A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases.
There are higher rates of suicide by self-poisoning among doctors than by people in other occupations. The rate of suicide was 62% higher among health professionals with ready access to prescription medicines, such as doctors, than among health professionals without such access. Women are more likely than men to choose poisoning as the method of suicide, with the lethality of self-poisoning increasing with access to prescription medicines.
Why?
Research has shown that medical professionals experience a considerable number of job stressors which have been associated with anxiety and depression, including:
- work-family conflict – the researchers suggest this is a significant stressor for female doctors who are combining work, family and child care responsibilities
- long working hours
- high job demands
- access to controlled substances
- fear of making mistakes at work
- exposure to vicarious trauma through contact with patients and their families.
This inquest and study reminds all of the importance of looking after ourselves and looking out for our colleagues, seeking support where and when appropriate.
Post by Claudine Watson-Kyme